Cognitive treatments for depression

How does CBT begin?

• Starts with an assessment in which the patient & therapist work together to clarify the patient’s problems

• They jointly identify goals for the therapy & put together a plan to achieve them

What is the central task of CBT?

To identify where there may have been irrational thoughts & how these will be challenged

What two types of cognitive treatment for depression exist?

CBT & REBT

Who developed CBT?

Beck

What types of thoughts does Beck’s CBT try to challenge?

• The negative triad

• Irrational beliefs

• Negative self-schemas

In Beck’s CBT, how does the patient test the reality of their irrational beliefs?

Using the “patient as a scientist” approach

What is an example of a “patient as a scientist” approach?

The therapist sets the patient homework to record when they enjoyed an event or people were nice to them

How does the therapist use this evidence (i.e. setting homework) in later sessions?

To challenge negative thoughts

Who developed REBT?

Ellis

What does REBT stand for?

Rational Emotive Behavioural Therapy

What letters would you associate with REBT?

ABCDE

What do the letters D & E stand for?

Dispute & effect

What is the purpose of dispute?

To challenge irrational thoughts (e.g. utopianism using vigorous argument which breaks the link between negative life events & depression)

What two arguments are used to dispute irrational beliefs?

Empirical argument & logical argument

What is the empirical argument based on?

Whether there is actual evidence to support the negative belief

What is the logical argument based on?

Whether the negative thought logically follows facts

CBT also involves behavioural activation to provide evidence for beliefs being rational. What is behavioural activation?

Where the patient engages in enjoyable activities

Describe and evaluate the cognitive approach to treating depression (16 marks)

Write your AO1 paragraph

• Firstly, one cognitive treatment for depression is CBT (developed by Beck), which begins with an assessment where the patient & therapist work together to identify the patient’s problems. They jointly identify goals & put together a plan to achieve them. One of the tasks is to identify where there have been irrational thoughts & how these will be challenged.

• CBT also identifies & challenges negative, automatic thoughts about the world, the self & the future (Beck’s negative triad). It also helps patients to test the reality of their negative beliefs by using the ‘patient as a scientist’ approach (e.g. setting homework to record when they enjoyed an event or people were nice to them). CBT also involves behavioural activation, where the patient engages in enjoyable activities - the therapist can then use this evidence in later sessions to challenge negative thoughts & irrational beliefs.

• Secondly, another cognitive treatment for depression is Ellis’ Rational Emotive Behavioural Therapy (REBT), which extends the ABC model to an ABCDE model, where D stands for dispute & E stands for effect.

• REBT aims to identify & dispute irrational thoughts, which can involve empirical argument (whether there is actual evidence to support the negative belief) & logical argument (whether the negative thought logically follows facts).

Describe and evaluate the cognitive approach to treating depression (16 marks)

Write your strength AO3 PEEL (March et al.)

• Point: One strength of the cognitive treatment for depression is there is research evidence in support of the effectiveness of CBT.

• Evidence: For example, March et al. compared CBT, anti-depressants (e.g. SSRIs, such as Prozac) & a combined treatment approach in 327 adolescents with depression.

• Explain: Results found that after 36 weeks, 81% of the CBT group, 81% of the anti-depressant group & 86% of the combined treatment group showed significant improvement.

• Link: Therefore, this suggests CBT is equally as effective as drug therapy & supports the cognitive approach by showing that targeting irrational & maladaptive thought processes can reduce depressive symptoms.

Describe and evaluate the cognitive approach to treating depression (16 marks)

Write your limitation AO3 PEEL (limited applicability)

• Point: One limitation of the cognitive treatment for depression is that CBT may have limited applicability, as it may not be effective for all types of patients.

• Evidence: For example, severely depressed patients with avolition may be unable to motivate themselves to engage with therapy or concentrate during sessions.

• Explain: As CBT requires active participation, such as challenging negative thoughts & completing tasks (e.g. ‘patient as a scientist’ approach), patients with more severe symptoms may struggle to benefit fully.

• Link: As such, this suggests an interactionist approach may be the most effective treatment method, where biological treatments (e.g. SSRIs) are used first to reduce emotional symptoms, followed by cognitive treatments (e.g. CBT) to address maladaptive thought patterns.

Describe and evaluate the cognitive approach to treating depression (16 marks)

Write your limitation AO3 PEEL (CBT’s focus)

• Point: One limitation of the cognitive treatment for depression is that CBT may not be suitable for all patients due to its primary focus on the present & future.

• Evidence: For example, some patients may wish to delve into & explore their past experiences (e.g. childhood events) which they believe have contributed to their current psychological difficulties.

• Explain: This suggests CBT’s approach may be frustrating for these individuals, as it does not prioritise uncovering the source & root causes of their problems.

  Link: Overall, patients may feel their concerns are not fully addressed, which could reduce engagement during sessions, limiting its overall effectiveness.